Study Gives 'Striking' Snapshot of Stroke Prognosis
Two-Thirds of Medicare Patients Face Death, Hospital Readmission in Year After Stroke
By Denise Mann
WebMD Health News
Reviewed by Louise Chang, MD
elderly man in hospital bed

Dec. 16, 2010 -- Nearly two-thirds of Medicare patients who are discharged after having a stroke will die or be readmitted to the hospital within a year, according to a new study in the journal Stroke.

The findings are “striking,” says study author Gregg C. Fonarow, MD, the Eliot Corday Professor of Cardiovascular Medicine and Science and the director of the Ahmanson-UCLA Cardiomyopathy Center in Los Angeles.

Fonarow and colleagues analyzed the death and hospital readmission rates for more than 91,000 Medicare beneficiaries treated for ischemic stroke at 625 hospitals from April 2003 and December 2006. The most common type of stroke, ischemic strokes occur when blood flow to the brain is blocked.

In-hospital death rates are about 14% within a month and 30% within one year of hospital admission for stroke. Within one year of hospital discharge, the stroke death or readmission rate is close to 62%, the new study showed. There were no improvements in death or rehospitalization rates from 2003 to 2006.

A Visual Guide to Understanding Stroke
Wide Variation From Hospital to Hospital

There was variation in rates by hospital. For example, the 30-day death rate after admission for stroke was as low as 9.8% in the top-performing hospitals to 17.8% in the bottom-performing hospitals, the study showed.

There were also no significant differences in readmission or death rates in hospitals that were certified as primary stroke centers. A primary stroke center is a hospital that provides emergency care to people having a stroke or admits stroke patients and offers additional care or transfers patients to a comprehensive stroke center when needed.
Findings Likely Apply to All Senior Citizens With Stroke

The new study only looked at Medicare beneficiaries, but the findings are likely generalizable, Fonarow says.

About 65% of patients hospitalized for stroke are aged 65 or older, which is the age that most people become eligible for Medicare. “The [new] findings thus are likely generalizable to these patients, however, whether similar findings would be seen in younger patients needs further study,” he says.

The death and rehospitalization rates seen in the study are likely due to the severity of the stroke, presence of other related health problems, and the in-hospital and follow-up care, he says.

“Between of the acute presentation with an ischemic stroke and a readmission to the hospital or postdischarge death, a window of opportunity exists for interventions to reduce the burden of postischemic stroke morbidity and mortality,” he says.